1. Path Quiz 2

B. Lymph returns blood to the venous system. The venous systems has a stronger osmotic pressure whil the arterial system has a greater hydrostatic pressure. The hydrostatic pressure in the arterial systems forces transudate into the interstitial and cellular space. This raises the hydrostatic pressure in these areas which cause for ENDOTHELIAL END SACS to open and for fluid to flow into the lymph vessels.

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The driving force behind the movement of fluid in the lymphatic system isA. High plasma hydrostatic pressure which causes H20 to enter tissue
B. High tissue plasma hydrostatic pressure which causes H2O to enter the blood vessels
C. High plasma osmotic pressure which causes H20 to be sucked into the tissue
D. High tissue osmotic pressure which causes the H20 to be sucked into the blood vessels

b. This will raise the plasma hydrostatic pressure. Which is created by stretching the tissue. As

blood is forced into the aorta, the hydrostatic pressure rises because of the arteries resistance to stretch as they fill. Thus we see that the arteries have a higher hysdrostatic pressure and the veins have a higher osmotic pressure (tendency to “suck” blood in)

T/F albumin helps to regulate osmotic pressure?

T

T/FThe deeper vessels of the lymphatci system have their own valves and smooth muscles which keep the fluid moving in the right direction.

T.

Of the fluid that leaks out of the blood, what percentage returns directly back to the venous systems?
A. 75%B. 90%
C. all of it
D. 50%

B. 90%

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Why does blood leak out one side and get taken back in the other.
A. Low hydrostatic pressure in the arterial side and high osmotic pressure in the venous side.B. High hydrostatic pressure in the arterial side and high osmotic pressure in the venous side.
C. High tissue hydrostatic pressure and high tissue osmotic pressure
D. hydrostatic pressure in the arterial side and low osmotic pressure in the venous side.

B.

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T/F Injury to a blood vessel means injury to the lymphatic system in the area.

T.

John has lymphadenitis which has disrupted the flow of lymph. What is true of the circumstance?A. afferent lymph vessels will increase in hydrostatic pressure
B. afferent lymph vessels will increase in osmotic pressure
C. efferent lymph vessels will increase in hydrostatic pressure
D. efferent lymph vessels will decrease in osmotic pressure

A. Sincelymph is no longer flowing through the nodes at a normal pace there will be an increase in hydrostatic pressure within the afferent lymph vessels. There will by many lymphocytes and macrophages in the nodes.

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Endothelial end sacs
A. are pushed open by osmotic plasma pressure
B. are pushed open by osmotic tissue pressureC. are pushed open by hydrostatic tissue pressure
D. are pushed open by hydrostatic plasma pressure

C.The endothelial end sacs are pushed open directly by an increase in the tissue hydrostatic pressure. The hydrostatic plasma pressure is what causes fluid to be pushed from the blood into the tissue causing that rise in tissue hydrostatic pressure. The end sacs are then opened up and fluid is pushed into the lymph vessels.

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Pt. presents with swollen and palpable lymph nodes, the best thing to do is
A. perform craniosacral therapy on him.B. refer him to a physician
C. send him home to rest
D. send him to the E.R.

B. Any inflammation of the lymphs nodes that is palpable is an indication for a referral to a physician.

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Pt.presents with severe swelling in their left leg. The tissue is soft and pits. You send her home to elevate the leg and successfully reduce the swelling this would be
a. fat leg syndrome
b. stage I lymphedema
c. stage II lymphodema
d. stage II lymphodema

b. Assuming

the the patient has a type of lymphedema, it would be stage I according to the International Society of Lymphology (ISL) scale.

Stage I: soft and pitting with reversibility with elevation.

Stage II: nonpitting and not see reversal with elevation, clinical fibrosis, and skin changes.

Stage III: know as lymphostatic elephantitis and has severe nonpitting and fibrotic edema. There are also atrophic changes in the skin leaving it thick and leathery, keratotic skin, skin folds with tissue flaps, warty protrusions, papillomas (mole like) and leaking lymph fistulae or wounds.

Of the know causes of lymphedema, the ration of incidence or females to males is
A. 4:1
B. 1:4
C. 2:1
D. 1:2E. not reported

E. The notes don't talk about the ration for secondary lymphodema. But in primary lymphodeman (idiopathic), the ratio is 4:1 for women to men

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Juan lives in deep in the Congo, he has a fat swollen leg that looks rubbers and has sores leaking fluid all over it. The most probably cause of his stage III lymphedema is
a. idiopathic
b. MSM
c. cancer
d. filarial worm

d. Most cases of lymphodema in tropical regions is caused by the filarial worm. Filiariasis

is a major cause in tropical climates. The worm can reach up to 20 cm and 2 cm in diameter and the male has a whipping tail that can damage the endothelium of the lymphatic vessels and when they die the can cause even greater inflammation.

Which of the following would not be a known cause of lympedema?
A. Repeated pregnancies
B. Liposuction
C. bacterial of viral infectionD. Scraps and bruises
E. Compound fractures
F. Multiple abdominal surgeries
i. severe lacerations
j. Crush injuries

D. scraps and bruises

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Which would not be a pathogenesis of lyphodema
A. increase in channel size leading to greater distance for O2 to travels leading to hypoxia of tissues.B. increases in venous osmotic pressure
C. normal or increased lymph load with inadequate transport
D. chronic inflammation in lymphedematous tissue leading to tissue fibrosis

B. In theory increased venous osmotic pressure would assist in the movement of blood.

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T/F Anything that causes a lack of variation in total tissue pressure may cause lymphodema.

T

Which is not a step in treating lymphedema?
A. increase proteolysisB. use of diuretics
C. undergoing any cancer treatments with out fear of developing lymphodema
D. treat for cancer first.

B. use if diuretics does not help lymphedema. If you have cancer, you must treat for cancer with out worrying about developing lymphedema. The notes say an increased level of proteolysis helps to reduce the interstitial protein and soften tissue and increase healing, but I am not sure how you do that.

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Lymphangitis is notA. best treated with oral antibiotics
B. known to cause red streaks in skin leading toward the nodes
C. easily overlooked in humans with dark skin
D. usually caused by strep of staph in the lymph channel

A.

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Any individual with an impaired lymphatic system should not
a. be evaluated by a physician immediately
b. receive heat to improve circulation of fluid to and from area.
c. rest and immobilize the area
d. outline the original areas or redness.

b. heat will cause vasodilation. The problem is there is too much fluid in

the area and inadequate lymph transportation. Heat would amplify the

problems.

What do we call a thickened cutaneous fold of skin over the second toe?
A. stripper’s sign
B. stomper’s signC. stemmer’s sign
D. stepper’s sign

C.

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T/F Formation of platelets, erythrocytes, leukocytes, and plasma occurs in the bone marrow and is controlled by hormones.

F. Plasma is not formed in the bone marrow.

Which of the following is not part of the lymphatic part of the hematologic system?
A. bone marrowB. thyroid
C. spleen
D. peyer’s patches
E. thymus

B. Peyer's patches are small patches of lymphatic tissue in the small intestine.

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The following are common ways of blood doping.
A. Anabolic steriods
B. infusion of WBC
C. androgenergic stimulantsD. exogenous erythropoietin

D.

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T/F Patient will have asignificantly different blood composition today than he/she did 20 years ago.

F

T/F General antihistamines are often accompanied with blood transfusions.

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In a bloodless medical program there are often low
A. Na levelsB. Hg. levels
C. RBC levels
D. Fe levels

B. Hg levels need to watch closed in bloodless Medicine. Hemoglobin less than 10 is contraindication for exercise.

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T/F Hemochromatosis is autosomal dominant heredity disorder found most often in men although there is equal prevelance. Why?

T. Hemochromatosis is a autosomal recessive hereditary disorder where the individual absorbs too much Fe. It is of equal prevelance between males and femals, however males experience symptoms more often. It is usually asymptomatic until around 50-60 yrs of age.

A female pt. present with disease causing a a lower capacity to carry oxygen, the disease is most likely
A. anorexia
B. anemiaC. SCD
D. amenorrhea

C. Sickle Cell Disease. Anemia is associated with a decreased ability to carry oxygen, but it is a symptom not a disease.

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Which is not a common type of anemia?
A. Iron deficiency associated with chronic GI blood loss secondary to NSAID useB. Infectious disease like YI or NST
C. Nutritional conditions
D. Chronic disease or inflammatory diseases such as RA and SLE
E. Neoplastic disease or cancer

B. Therapeutic phlebotomy is a good treatment. It works by thinning out the Fe in the blood.

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Which is of the following is a true statement?
A. Hematocrit is the number of Hg. in blood
B. Hematocrit is the percentage of WBC in blood
C. Hg. is the percentage of RBC in bloodD. Hg is the number of RBC in blood

D. Hg is the number of RBC in blood usually expressed in g/100mL. Hematocrit is the percentage of RBC in blood. (low 14g/mL and 12g/mL and 41% and 37% for males and females respectively)

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Pt. has Hg. count of 13g/100mL. The follwing may be true.
a. Anemia is present and they may have abdominal bleeding
b. Anemia is not present and they may have abdominal bleeding.
c. Anemia is present and they may have an auto immune disorder
d. Anemia is not present and they may have an auto immune disorder
e. All of the above
f. None of the above.

e. All cases may be true depending on the sex (<14 is anemia for males and <12 for females.) So depending and the gender they may or may not be classified as anemic, either why the count is really low, and an auto immune disorder may be destroying RBC or the may have a GI lesion. Anemia is often commonly caused by decrease production of RBC

Which is not a group of leukocytes?
A. Granulocytes
B. MonocytesC. Neutrocytes
D. Lymphocytes

C. Neutrocytes don't exist, A neutrophil is a type of granulocyte along with basophils and eosinophils.

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The main role of granulocytes is
A. forming macrophages
B. secreting cytokines
C. producing antibodiesD. lysing

D. Eosinophils, basophils, and especially neutrophils are all capable of lysing. Moncoytes are called macrophages once they enter the tissue. Lymphocytes produce antibodies and secret cytokines

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Leukocytosis is
a. a transient increase in leukocyte count that may indicate infection if over 3,000/mL
b. a reduction in leukocytes <10,000/mL
c. is a temporary increase in leukocyte count in blood
d. is a high number of lymphocytes

c. Leukocytosis is a transient increase in leukocytes where the blood count is >10,000/mL. Infection

is indicated at levels over 10,000/mL. A reduction in leukocytes is called leukopenia. Higher numbers of lymphocytes is called lymphocytosis

Pt. has a bacterial infection accompanied with high levels of herapin and histamine. What would be the main cause of this?
A. lymphocytosisB. basophilia
C. eosinophilia
D. leukopenia

B. Basophilserupt and release inflammation factors in response to bacterial and other infections. Just think B for bacteria and basophils.

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Pt. eats a food that he is allergic to, this is most likely to cause high levels of
a. eosinophils
b. basophils
c. allergophils
d. lymphocytes

a. eosinophilia is a high number of eosinophils usually the result of an allergic reaction. They

are usually late to arrive in inflammatory responses. They are weaker than neutrophils, but may perform phagocytosis. They also defend against parasitic infections.

This is the most plentiful of granulocytes and is usually used to describe
early stages of infection. They are the first phagocytic cells to reach
an infected area.
a. basophils
b. eosinophils
c. neutrophils
d. monocytes

c. Neutrophils. Neutrophilia is what we call a high number of neutrophils. Monocytes are not

granulocytes. They are the most plentiful of granulocytes and work together with moncytes. Neutrophilia is low levels of neutrocytes, usually occurring in prolonged infection when the production cannot keep

up with the demand.

Pt. who is healthy but has asthma would most likely have increased chances of
A. basophilia
B. neutrophilia
C. monocytosisD. lymphocytopenia

D. Asthma may often be treated by prednisone. Predisone causes decreases in lymphocyte levels. Basophilia is usually present in bacterial infections, neutrophilia is associated with early stages of infection, and monocytosis is seen in chronic infections pt is healthy so none of those would be the best choice.

C. Reed-Sternberg cells (double egg looking cells) are the difference between Hodgkin’s disease and Non-Hodgkin’s lymphoma (NHL) is usually caused by exposure of benzene and industrial pollutants and polychlorinated biphenyls (PCB)

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What is often the first symptom of NHL?A. lymphadenopathy
B. lymphocytosis
C. SCD
D. Reed-Sternberg cells

A. Lymphadenopathy (often pain less) is usually the first sign of NHL. This is why is it important refer a pt. with palpable lymph nodes. SCD-sickle cell disease. Reed-strenberg is with HD. Lymphocytosis would most likely be present with NHL, but isn’t necessarily a first sign.

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Pt. has RA and back pain along with enlarged lymph nodes. As a HCW you would suspect
A. HP
B. Hypoxia
C. ThyroidismD. NHL

D. NHL. thyroidism would need to be more specific, hypo? hyper? etc.

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Multiple Myeloma is
A. similar to plasma cell myeloma
B. very curable
C. a secondary malignant neoplasm of cells arising most often in bone marrowD. twice as prevelant as HD

D. It is a primary malignant neoplasm of cells arising most often in bone marrow, is the same thing as plasma cell myeloma, and it is incurable. Often express with bone pain and renal problems.

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A very common myeloproliferative disorder would
a. cause uncontrolled expansion of bone marrow elements
b. may progress to acute myeloid leukemia (CML)
c. cause erythroytosis called polycythemia Vera
d. all of the above.

d.

Hemostasis problems may be caused by.A. both
B. high platelet counts
C. low platelet counts.
d. none of the above

A.

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Apsrin is not recommend for individuals with Thrombocytopenia prombelms because
A. Asprin can induces platelet lysisB. it inactivates platelet cyclooxygenase
C. it thins blood
D. NSAIDs are bad

B. It does thin blood, but that best answer that it inactivates the cyclooxygenase which causes the platelets to have the inability to aggregate and effects vasoconstriciton

d. DIC is NUTZ because it causes both extra coagulation and hemorrhaging. Itis a condition where there is overactivation of both the coagulation and fibrinolysis. You will end up with hemorrhaging and clots all over, a seemingly paradoxical condition.

A. Severe may bleed spontaneously or with only slight trauma. Moderate may have major bleeding episodes after mild trauma, but not spontaneous bleeding. Mild have rare spontaneous hemorrhages.

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What is the most common form of treatment for pt. with hemophilia?A. factor replacement therapy
B. prenatal treatment
C. NSAIDs

A.

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Therapy for a pt. with hemophilia should not include
A. strengthening and coordination ex
B. methods to reduce and prevent deformity
C. functional training for ADL
D. methods to influence abnormal muscle tone and pathological patterns of movementE. Asprin and heat

E.

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Which is not a main neoplastic disease of the blood and lymph?
A. Malignant Lymphomas
B. Myeloproliferative disorders
C. Multiple Myeloma
D. LeukemiaE. SLE

E. Leukemia is the replacement of blood forming cells by malignant clones of lymphocytic or myelogenous cells. Malignant Lymphomas are cancers arising from the lymphoids (HD and NHL). Multiple Myeloma is an accumulation of monoclonal plasma cells in bone marrow that produce one class of immunoglobulin. Myeloproliferative disoreders are uncontrolled expansion of all bone marrow elements.